title: Mottling score predicts survival in septic shock.
abstract: BACKGROUND
  Experimental and clinical studies have identified a crucial role of microcirculation impairment in severe infections. We hypothesized that mottling, a sign of microcirculation alterations, was correlated to survival during septic shock.
  
  
  METHODS
  We conducted a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included during a 7-month period. After initial resuscitation, we recorded hemodynamic parameters and analyzed their predictive value on mortality. The mottling score (from 0 to 5), based on mottling area extension from the knees to the periphery, was very reproducible, with an excellent agreement between independent observers [kappa = 0.87, 95% CI (0.72-0.97)].
  
  
  RESULTS
  Sixty patients were included. The SOFA score was 11.5 (8.5-14.5), SAPS II was 59 (45-71) and the 14-day mortality rate 45% [95% CI (33-58)]. Six hours after inclusion, oliguria [OR 10.8 95% CI (2.9, 52.8), p = 0.001], arterial lactate level [<1.5 OR 1; between 1.5 and 3 OR 3.8 (0.7-29.5); >3 OR 9.6 (2.1-70.6), p = 0.01] and mottling score [score 0-1 OR 1; score 2-3 OR 16, 95% CI (4-81); score 4-5 OR 74, 95% CI (11-1,568), p < 0.0001] were strongly associated with 14-day mortality, whereas the mean arterial pressure, central venous pressure and cardiac index were not. The higher the mottling score was, the earlier death occurred (p < 0.0001). Patients whose mottling score decreased during the resuscitation period had a better prognosis (14-day mortality 77 vs. 12%, p = 0.0005).
  
  
  CONCLUSIONS
  The mottling score is reproducible and easy to evaluate at the bedside. The mottling score as well as its variation during resuscitation is a strong predictor of 14-day survival in patients with septic shock.
authors.affiliation: Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris Cedex 12, France. hafid.aitoufella@sat.aphp.fr
authors.forename: H
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: S
authors.initials: S
authors.lastname: Lemoinne
authors.forename: P Y
authors.initials: PY
authors.lastname: Boelle
authors.forename: A
authors.initials: A
authors.lastname: Galbois
authors.forename: J L
authors.initials: JL
authors.lastname: Baudel
authors.forename: J
authors.initials: J
authors.lastname: Lemant
authors.forename: J
authors.initials: J
authors.lastname: Joffre
authors.forename: D
authors.initials: D
authors.lastname: Margetis
authors.forename: B
authors.initials: B
authors.lastname: Guidet
authors.forename: E
authors.initials: E
authors.lastname: Maury
authors.forename: G
authors.initials: G
authors.lastname: Offenstadt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003955:Diagnostic Tests, Routine; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation / Q000276:immunology / Q000502:physiology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality / Q000503:physiopathology*; D012867:Skin / Q000098:blood supply; D016019:Survival Analysis